Fewer than Half of Schizophrenia Patients Get Proper Treatment

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Fewer than half of the patients under treatment for schizophrenia, a serious brain disorder, are
receiving proper doses of antipsychotic medications or appropriate psychosocial interventions.
This finding is from a national study on schizophrenia, funded by the Agency for Health Care
Policy and Research (AHCPR) and the National Institute of Mental Health (NIMH), and
published recently in NIMH's Schizophrenia Bulletin. The study identified gaps in effective care
for people with schizophrenia and opportunities for improvement in all aspects of treatment.

"Appropriate medication is the cornerstone to treating the illness, but medication alone is not
enough," said Anthony F. Lehman, M.D., Principal Investigator of the study and Director of the
Center for Mental Health Services Research at the University of Maryland School of Medicine.
"Clinicians understand the need to prescribe antipsychotic medications, but the most effective
approach integrates appropriate medication management with psychosocial treatments."

Schizophrenia may be the most disabling of all mental illnesses. The symptoms, which can be
devastating to the individual and his or her family and friends, impair a person's ability to make
decisions, manage emotions, interact with others, and think clearly. The symptoms commonly
include hallucinations, delusions, confused thinking, and blunted or altered emotions or senses.
It is not a multiple-personality disorder, as is often thought. Typically, schizophrenia has an early
onset (usually between the ages of 16 and 30). Up to 2 million people are treated for the illness
each year, and up to 100,000 patients with schizophrenia are in public mental health hospitals on
any given day.

The study's new evidence-based analysis is intended to inform health professionals of more
effective medical approaches to treat patients suffering from schizophrenia. The five-year
scientific study found that the key to improving outcomes for patients is adoption of a
comprehensive and individualized strategy—combining proper doses of appropriate medications,
patient and family education and support, and, for high risk patients, assertive community
treatment.

The researchers analyzed published research on schizophrenia and assessed the quality of
evidence for schizophrenia treatment. Then, to better understand how to improve care, they
studied how this evidence compares with current clinical practice. Their study evaluated care of
schizophrenic patients in outpatient and inpatient settings in both urban and rural settings. The
overall rates at which patients' treatments conformed to the study recommendations were
generally below 50 percent. An exception was the rate of prescription for antipsychotic
medications, which was found to be around 90 percent, although not always at an appropriate
dosage.

"This study is an excellent example of how research can identify opportunities for improvement
in health care quality," said AHCPR Administrator John M. Eisenberg, M.D. "The study gives
clinicians, patients and their families the basic, evidence-based information they need to form a
comprehensive treatment plan for people with schizophrenia."

"This is an extremely exciting time in schizophrenia research, with the recent introduction of
several new and safer antipsychotic medications, said Steven E. Hyman, M.D., Director,
National Institute of Mental Health. "The study's results demonstrate the importance of getting
information about the best available treatments to clinicians, large and small provider groups,
and patients and their families."

Other findings include:

Younger patients were more likely to be offered psychotherapy and vocational
rehabilitation. Minority patients were more likely to be on higher doses of antipsychotic
medications and less often prescribed an antidepressant when depressed.

Psychosocial treatments are often prescribed at the point of hospital discharge but follow-through in the community is low. Failure to offer these treatments for outpatients may be
a serious problem in ongoing community-based care.

Psychosocial treatment varied in conformance rates based on location. Patients in some
states are more likely than those of another to be prescribed a vocational intervention and
less likely to be prescribed a family intervention or psychotherapy.

This study was part of AHCPR's Patient Outcomes Research Team (PORT) program, which
examines the effectiveness and cost effectiveness of available treatments for common clinical
conditions. PORT projects focus on procedures and treatments whose use in the "real world"
setting of medical practice has not been rigorously evaluated.

The complete PORT findings are published in the Schizophrenia Bulletin, available from the
National Institute of Mental Health (301-443-4536). Reprints of the journal articles (packaged as
AHCPR Pub. 98-R036 and 98-R037) are available from the AHCPR Publications Clearinghouse.
Call 1-800-358-9295 or write to P.O. Box 8547, Silver Spring, MD 20907. Other information about schizophrenia is
available from the NIMH and from the National Alliance for the Mentally Ill (703-524-7600).